Journal of Human Growth and Development
Accidents
with poisonous
2015; 25(1):
54-62 animals in Brazil by age and sex
Journal of Human Growth and Development,
25(1): 54-62
ORIGINAL2015;
RESEARCH
ACCIDENTS WITH POISONOUS ANIMALS IN BRAZIL BY AGE AND SEX
Ageane Mota da Silva1, Paulo Sérgio Bernarde2, Luiz Carlos de Abreu3
DOI: http://dx.doi.org/10.7322/jhgd.96768
ABSTRACT
Introduction: accidents with poisonous animals are a common clinical emergency in several tropical
countries, mainly in the fields and rural areas, constituting a public health problem, including pediatric.
Objective: The objective is to analyze the morbidity, mortality and lethality according to age and
sex in cases of poisoning by snakes, scorpions and spiders in Brazil. Methods: data on poisoning by
snakes, scorpions and spiders that occurred from 2009 to 2013 were collected in the online database
of the Information System on Diseases of Compulsory Declaration (SINAN) of the Ministry of Health.
Results: were recorded 28.812 cases of snake bites per year, 60.370,8 with scorpions and 25.786,4
with spiders. Most deaths were caused by snakes (119 per year) and also showed higher lethality
(0.41%), followed by scorpions (79.6 deaths) with a lethality of 0.13% and spiders (13.2) and the
lowest mortality (0.05%). In males individuals were most cases of snake bites, whereas in accidents
scorpions and spiders was observed little difference in frequency between men and women. The age
group with the largest number of poisonings records was 20-39 years. Conclusions: there is a
progressive increase in cases of poisoning from the first year of age until the age range 20-39 years,
and after this, begins a decrease in cases. Children, adolescents and elderly adults are most vulnerable
because they have higher lethality rates, especially in the snake and scorpion accidents.
Key words: snake bites, ophidism, scorpionism, araneism.
INTRODUCTION
Accidental poisoning by venomous animals is
a common clinical emergency in several tropical
countries, mainly in the fields and rural areas of
Latin America, Africa, Asia and Oceania.1,2 In Brazil,
during the year 2013, health officials recorded
158,002 cases of poisoning by venomous animals;
of these, the majority (123,128 cases) was caused
by snakes, scorpions, and spiders.3 Poisoning by
venomous animals and their consequences
constitute a public health problem and, in particular,
a paediatric concern in many countries.1
The World Health Organization (WHO) in 2009
included snakebite on its Neglected Tropical Diseases
List.2 It is estimated that 1.841 million cases of
poisoning occur every year on the planet, resulting
in 94,000 deaths. In Brazil, poisoning by snakes
represents approximately 29,000 cases per year,
an average of 125 deaths.4 Regarding arachnids,
there were 69,036 cases of people bitten by
scorpions in 2013, resulting in 80 deaths and 27,125
cases of poisoning by spiders, from which 36 died.3
1
2
2
There are 62 species of venomous snakes
known in Brazil,4 which are classified into four
groups: Bothropic (Genus Bothrops and
Bothrocophias - lanceheads, responsible for
86.23% of cases); Crotalic (Genus Crotalus rattlesnakes, accounting for 9.17% of
cases); Lachetic (Genus Lachesis - bushmaster,
accounting for 3.72% of cases); Elapidic
(Genus Micrurus - coral snake, responsible for
0.86% of cases). The epidemiological profile of
snakebite victims is a rural male worker between
the ages of 15 to 49, usually affected on the lower
limbs.5,6 The lethality of snakebite is 0.44%,4 and
there is an association between the severity of cases
and age (children under 10 years and older adults
experience the worst consequences).7-9
The scorpions of medical interest in Brazil
belong to the genus Tityus; three main species
are responsible for serious, even fatal, poisonings
in humans in the South, Southeast, Midwest and
Northeast Brazil 6,10 : T. bahiensis (brazilian
scorpion), T. serrulatus (yellow scorpion)
and T. stigmurus.
Instituto Federal de Educação Ciência e Tecnologia do Acre. Cruzeiro do Sul - Acre.
Universidade Federal do Acre, Campus Floresta, Laboratório de Hepetologia, Cruzeiro do Sul - Acre.
Faculdade de Medicina do ABC - Departamento de Saúde Coletiva. São Paulo- SP.
Corresponding author: [email protected]
Suggested citation:Mota da Silva A (2015), Bernarde PS, Abreu LC. Accidents with poisonous animals in Brazil by age and sex. Journal
of Human Growth and Development. 25(1): 54-62
Manuscript submitted May 08 2014, accepted for publication Oct 29 2014.
– 54 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
Two species (Tityus metuendus and
T. obscurus) are known in the Amazon and stand
out due to their potential for serious harm to
humans. 11 Accidents with scorpions show little
difference between men and women with a lethality
of 0.2%. Children under 10 years are the most
vulnerable group.6.
In Brazil, the Ministry of Health is mainly
interested in the next three genera of
spiders6,12: Phoneutria (wandering spider), Loxosceles
(brown spider) and Latrodectus (widow spider). The
most important form of poisoning by spider in Brazil
is the bite of the brown spider brown (Loxosceles),
which presents the most lethal poison (lethality rate
of 0.05%) and is responsible for the most accidents
(loxoscelism) in the south of the country. Most
accidents occur in young adults and women
experience a higher prevalence of cases, while men
are more affected in cases of phoneutrism
(Phoneutria) and latrodectism (Latrodectus).
The objective is to analyze the morbidity,
mortality and lethality according to age and sex in
cases of poisoning by snakes, scorpions and spiders
in Brazil.
METHODS
This is a descriptive and retrospective study
analysing an online database, the Information
System of Notifiable Diseases (SINAN) from the
Ministry of Health 3 where the accidents by
poisonous animals that occur in the country are
recorded. The SINAN record, accessible in
hospitals, has 64 variables of which 21 are
available online. From these online variables, we
considered the following for this study: the kind
of causative animal (snake, scorpion, or spider),
Snakes
distribution of poisoning by snake genus
(Bothrops, Crotalus, Lachesis, and Micrurus) and
spider genus (Phoneutria, Loxosceles, and
Latrodectus ), age and sex of the victim, pregnant
women, and deaths. The cases of poisoning by
snakes, spiders and scorpions between the years
2009 and 2013 were recorded. The data
collected were grouped into Excel spreadsheets
to make the calculations of means, percentage,
and lethality. Lethality rate was obtained by
dividing the number of deaths that occurred due
to the certain type of poisoning by the number of
cases registered by the same type of accident and
then multiplying by 100. The result was expressed
as a percentage.
RESULTS
A total of 144,060 snakebites (mean of
28,812 cases per year), 301,854 accidents involving
scorpions (mean of 60,370.8 cases per year) and
128,932 accidents with spiders (mean 25,786.4
cases per year) were recorded between 2009 and
2013 (Tables 1, 2, and 3). Most deaths were caused
by snakes (mean of 119 per year), which also
showed higher lethality (0.41%), followed by
scorpions (mean of 79.6 deaths per year) with a
lethality rate of 0.13% and spiders (13.2 deaths
per year), the lowest lethality (0.05%). Most cases
of snakebites (76.9% of cases) involved males,
while only a little difference in frequency was
observed when comparing men and women in
accidents with scorpions and spiders (Figure 1). The
largest number of poisonings by snakes, scorpions
and spiders occurred to people between 20 and 39
years old, followed by those 40 to 59 years old
(Tables 1, 2, and 3; Figure 2).
Scorpions
Spiders
Figure 1: Proportion of male (black columns) and female (grey columns) individuals in accidents by
snakes (144,060 cases), scorpions (301,854), and spiders (128,932) in Brazil during the years 2009 to
2013 (total number of cases).
– 55 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
Table 1: Distribution of cases (= no.), deaths and lethality (= LET) for snakebites per age group and sex
in Brazil - mean of the period 2009 to 2013 (Source: SINAN / SVS / MS3)
Age
<1
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
> 80
Unknown
Sex
Man
Woman
Unknown
Pregnant
Total
no.
%
DEATHS
LET
no.
%
LET
no.
%
LET
334.2
566.2
1.431.8
2.502.6
2.839
10.164.6
8.046.2
1.170.4
785.2
765.2
202.8
3.8
1.15
1.96
4.96
8.68
9.85
35.27
27.9
4.06
2.72
2.65
0.7
0.01
1.2
2.6
5.4
8
4.8
29.8
38.2
8.2
3.8
12.6
4.4
0
0.35%
0.45%
0.37%
0.31%
0.16%
0.29%
0.47%
0.7%
0.48%
1.64%
2.16%
0
260
336.8
923.8
1.815.6
2.222.6
8.097.4
6.227
921.2
616.2
582.6
150.8
3.2
1.18
1.52
4.16
8.2
10.05
36.55
28.1
4.15
2.78
2.62
0.68
0.01
0.46
0.59
0.45
0.33
0.13
0.31
0.49
0.56
0.48
1.61
1.98
74
229.4
508
686.6
616.2
2.065.8
1.817.6
249
169
182.6
51.8
0.4
1.11
3.45
7.63
10.32
9.26
31.06
27.34
3.75
2.55
2.75
0.78
0.006
0
0.26
0.23
0.29
0.29
0.22
0.41
1.2
0.47
1.75
2.7
22.157
6.650.4
4.6
149.8
76.9
23.08
0.01
0.51
92.8
26.2
0
2
0.41%
0.39%
0
1.33%
28.812
100
119
0.41%
22.157.2
100
6.650.4
100
Table 2: Distribution of cases (= no.), deaths and lethality (= LET) by scorpion according to age and sex
in Brazil - mean of the period 2009 to 2013 (Source: SINAN / SVS / MS3)
Age
no.
%
DEATHS
LET
no.
%
LET
no.
%
LET
<1
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
> 80
Unknown
809.4
2.875.4
3.819.6
4.549.8
5.135.2
20.073.4
15.367.6
2.603.8
1.917.2
2.372.2
834.8
12.4
1.35
4.76
6.32
7.54
8.50
33.25
25.45
4.32
3.18
3.92
1.39
0.02
1.6
17.2
13.8
6.4
4.6
17.6
11
2.4
1.6
2.2
1.2
0
0.19%
0.59%
0.36%
0.14%
0.08%
0.08%
0.07%
0.09%
0.08%
0.09%
0.14%
0
432.6
1.547.6
1.981.6
2.314.8
2.526.4
10.218
7.492.6
1.258.6
898.8
1.032.8
338
6.20
1.44
5.15
6.60
7.70
8.40
34
24.94
4.18
3
3.44
1.13
0.02
0.18
0.68
0.30
0.13
0.06
0.10
0.08
0.09
0.06
0.13
0.05
376.6
1.327.6
1.837.4
2.234.4
2.608
9.852
7.872.8
1.345.2
1.018.2
1.338.8
496.6
6.2
1.24
4.38
6.06
7.37
8.60
32.50
25.97
4.44
3.36
4.42
1.64
0.02
0.21
0.49
0.42
0.14
0.11
0.07
0.06
0.08
0.09
0.05
0.16
Man
Woman
Unknown
30.048
30.313.8
9
49.78
50.21
0.01
42.6
37
0
0.14%
0.12%
Pregnant
623
1.03
1
0.16%
Total
60.370.8
100
79.6
0.13%
30.048
100
30.313.8
100
Sex
Table 3: Distribution of cases (= no.), deaths and lethality (= LET) by spiders by age and sex in Brazil mean of the period 2009 to 2013 (Source: SINAN / SVS / MS3)
Age
no.
%
DEATHS
LET
no.
%
LET
no.
%
LET
<1
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
> 80
Unknown
320
1.234.4
1.193
1.338.6
1.974.6
8.700.6
7.502
1.250.4
930.4
1.049.6
287.4
5.2
1.250
4.800
4.630
5.200
7.700
33.800
29.200
4.900
3.300
4.100
1.120
0.002
0.2
0.8
0.6
0.6
1.2
3.2
3.4
1
1
0.6
0.6
0
0.06
0.06
0.05
0.04
0.06
0.03
0.04
0.07
0.10
0.05
0.2
0
174.6
681.8
649.8
754.4
981
4291.2
3811.8
716.2
539.6
609.2
153.6
3
1.30
5.10
4.86
5.65
7.35
32.10
28.52
5.35
4.04
4.56
1.15
0.02
0
0
0
0
0.04
0.02
0.03
0.08
0.07
0.03
0.13
0
145.2
552.6
542.6
583.8
993.6
4407.6
3688.2
534
390.4
440.2
133.8
2.2
1.18
4.45
4.38
4.7
8
35.5
29.7
4.3
3.15
3.55
1.08
0.01
0.13
0.14
0.11
0.03
0.06
0.03
0.04
0.03
0.15
0.09
0.29
0
13.366.2
12.414.2
5.8
51.84
48.15
0.02
5.8
7.4
0
0.04
0.05
Pregnant
228.8
0.88
0
0
Total
25.786.2
100
13.2
0.05
13.366.2
100
12.414.2
100
Sex
Man
Woman
Unknown
– 56 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
Snakes
Scorpions
Spiders
<1
1 to 4
5 to 9
10 to 14
15 to 19 20 to 39 40 to 59
60 to 64 65 to 69
70 to 79 80 or +
Figure 2: Distribution of percentage of accidents with snakes, scorpions, and spiders by age group in
Brazil from 2009 to 2013
Regarding snakebites, there is a progressive
increase in poisonings from the first year of age
until the age of 20-39 years; after this, the number
of cases begins to decline. A higher number of
deaths were registered for individuals from 20 to
59 years (average of 68 deaths per year = 57.14%)
and a higher lethality occurred after 60 years old
(0.7% lethality) (Table 1). The highest lethality rates
were observed between ages 70-79 years (1.64%)
and over 80 years (2.16%). In pregnant women
(0.5% of snakebites recorded), a higher lethality
(1.33%) was observed in relation to lethality in
women (0.39%).
Most cases of poisoning by snakes were
bothropic accidents (86.2%) (Table 4) followed by
crotalic (9%), lachetic (3.9%), and elapidic (0.9%)
Table 4: Distribution of types of snake bites according to age group (total number of cases from 2009 to
2013) (Source: SINAN / SVS / MS 3)
Faixa
Age
Etária
group
Botrópico
Bothropic
No casos
no.
cases
Botrópico
Bothropic
%
%
Cotrálico
Crotalic
No casos
no.
cases
Cotrálico
Crotalic
%
%
Laquético
Lachetic
No casos
no.
cases
Laquético
Lachetic
%
%
Elapidic
No casos
no.
cases
<
<1
1
1-4
1-4
5-9
5-9
10-14
10-14
15-19
15-19
20-39
20-39
40-59
40-59
60-64
60-64
65-69
65-69
70-79
70-79
> 80
>
80
1.186
1,186
1.845
1,845
5.058
5,058
9.028
9,028
10.253
10,253
37.047
37,047
29.593
29,593
4.363
4,363
2.837
2,837
2.774
2,774
739
739
1,14
1.14
1,76
1.76
4,83
4.83
8,63
8.63
9,8
9.80
35,38
35.38
28,25
28.25
4,16
4.16
2,7
2.70
2,65
2.65
0,7
0.70
115
115
171
171
468
468
709
709
905
905
3.731
3.731
3.502
3.502
494
494
383
383
375
375
8080
1,05
1.05
1,56
1.56
4,28
4.28
6,48
6.48
8,28
8.28
34,13
34.13
32,04
32.04
4,52
4.52
3,5
3.5
3,43
3.43
0,73
0.73
58
58
73
73
286
286
519
519
536
536
1.814
1.814
1.065
1.065
166
166
104
104
95
95
22
22
1,22
1.22
1,55
1.55
6,03
6.03
10,95
10.95
11,33
11.33
38,28
38.28
22,48
22.48
3,5
3.5
2,2
2.2
22
0,46
0.46
12
12
55
55
41
41
65
65
97
97
447
447
293
293
45
45
14
14
30
30
88
Total
Total
104.723
104.723
(86,2%)
(86.2%)
100
100
10.933
10.933
(9%)
(9%)
100
100
accidents. A larger number of cases of elapidic
poisoning was observed (4.95%) in children 1 to
4 years of age when compared to the frequency of
poisonings with other types of snakes in this age
group (bothropic, 1.76%; crotalic, 1.56%; lachetic
1.55%). The highest lethality was recorded in
crotalic poisonings (0.96%) (Table 5) followed by
4.738
4.738
(3,9%)
(3.9%)
100
100
1.107
1.107
(0,9%)
(0.9%)
Elepídico
Elapidic
%
%
1,08
1.08
4,95
4.95
3,7
3.70
5,87
5.87
8,85
8.85
40,37
40.37
26,46
26.46
4,05
4.05
1,25
1.25
2,7
2.70
0,72
0.72
100
100
lachetic (0.61%), bothropic (0.37%), and elapidic
(0.27%). The four types of poisoning showed a
higher incidence of lethality in individuals over 60
years old. All types of poisoning predominated in
males (Figure 3), In relation to the victim’s sex
and the type of snake, there were differences in
the proportion of victims as follows: lachetic
Table 5: Distribution of deaths and lethality (= LET) by types of snakebites according to age group
(total number of obits from 2009 to 2013) (Source: SINAN / SVS / MS 3)
Age
Group
Bothropic Bothropic
deaths %
Let.
Crotalic
deaths %
Crotalic
Let.
Lachetic
deaths %
Lachetic
Let.
Elapidic
deaths %
Elapidic
Let.
<1
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
> 80
3(0.76)
10(2.57)
17(4.36)
25(6.42)
13(3.33)
101(25.9)
134(34.36)
26(6.66)
11(2.83)
40(10.25)
10(2.56)
0.25
0.54
0.33
0.27
0.12
0.27
0.45
0.59
0.38
1.44
1.35
2(1.88)
1(0.95)
6(5.66)
6(5.66)
7(6.6)
17 (16.04)
34 (32.08)
6(5.66)
6(5.66)
13 (12.26)
8 (7.55)
1.73
0.58
1.28
0.84
0.77
0.45
0.97
1.21
1.56
3.46
10
1(3.44)
1(3.44)
1(3.44)
3(10.36)
0(0)
14 (48.3)
5(17.26)
1(3.44)
1(3.44)
1(3.44)
1(3.44)
1.72
1.36
0.34
0.57
0
0.77
0.46
0.6
0.96
1.05
4.54
0(0)
0(0)
0(0)
1(33.33)
0(0)
1(33.33)
0(0)
1(33.33)
0(0)
0(0)
0(0)
0
0
0
1.53
0
0.22
0
2.22
0
0
0
Total
390 (100)
0.37
106 (100)
0.96
29 (100)
0.61
3 (100)
0.27
– 57 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
( 8 1 . 7 6 % ) ; c r o t a l i c ( 8 0 . 7 3 % ) ; bothropic
(77.58%); and elapidic (71.06%) accidents.
There was also an increase in cases of
poisoning as victims’ age increased in accidents with
scorpions and spiders. The majority of accidents
Bothropic
were recorded between 20 and 39 years old and a
reduced frequency was observed in later years
(Table 2 and 3). Most deaths (mean of 32.6 per
year = 41%) and lethality rates in scorpion accidents
was observed in children under nine years of age.
Crotalic
Lachetic
Elapidic
Figure 3: Proportion of male (black columns) and female (grey columns) individuals with snakebites
(bothropic = 104,722 cases; crotalic = 10,933 cases; lachetic= 4,737 cases; elapidic = 1,106 cases) in
Brazil from 2009 to 2013 (total numbers).
Poisoning by spiders has a higher death frequency
in adults aged between 20 and 59 years (mean of
6.6 deaths per year = 50%).
Of the 128,932 cases of accidents with spiders
during 2009-2013, only 59,700 (46.3%) had
recorded the genus of the spider (Tables 6 and
7). Most cases corresponded to loxoscelism (66.3%)
followed by phoneutrism (32.8%) and latrodectism
(0.9%). During the study period, 66 deaths were
due to poisoning by spiders of which only 24 recorded
the genus of the spider. Most of deaths were
attributed to the genus Loxosceles (lethality 0.04%)
followed by Phoneutria with 5 deaths (0.02%) and
Latrodectus with one (0.17%). The majority of the
victims in accidents with Phoneutria (59.42% of
cases) and Latrodectus (55.35%) were male
individuals, while females had a higher incidence of
cases with Loxosceles (56.4 %) (Figure 4).
Table 6: Distribution of types of accidents and type of causer spider according to age group (total number
of cases from 2009 to 2013) (Source: SINAN / SVS / MS3).
Age
group
Phoneutria
no. cases
Phoneutria
%
Loxosceles
no. cases
Loxosceles
%
Latrodectus
no. cases
Latrodectus
%
<1
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
> 80
179
710
833
888
1,252
5,605
6,325
1,206
1,027
1,193
305
0.92
3.64
4.26
4.55
6.41
28.71
32.4
6.18
5.26
6.11
1.56
448
1.911
1.745
1.858
3.230
15.196
11.333
1.502
1.057
1.043
294
1.13
4.82
4.4
4.69
8.15
38.36
28.6
3.8
2.67
2.63
0.75
13
25
30
42
49
190
136
18
25
26
6
2.32
4.46
5.36
7.5
8.75
33.9
24.3
3.21
4.5
4.64
1.07
19,523
100
39.617
100
560
100
Total
(32.8%)
(66.3%)
(0.9%)
Table 7: Distribution of deaths and lethality (= LET) according to type of spider by age group from 2009
to 2013 (total number of deaths)
Age
Groups
Phoneutria
Deaths (%)
Phoneutria
LET.
Loxosceles
Deaths (%)
Loxosceles
LET.
Latrodectus
Deaths (%)
Latrodectus
LET.
<1
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
> 80
0 (0)
0 (0)
0 (0)
2 (40)
0 (0)
0 (0)
0 (0)
1 (20)
1 (20)
0 (0)
1 (20)
0
0
0
0.22%
0
0
0
0.11%
0.11%
0
0.11%
0
2 (11.11)
2 (11.11)
1 (5.56)
1 (5.56)
5 (27.77)
4 (22.22)
2 (11.11)
0
1 (5.56)
0
0
0.1%
0.11%
0.05%
0.03%
0.03%
0.03%
0.13%
0
0.09%
0
0
0
0
0
0
0
1 (100)
0
0
0
0
0
0
0
0
0
0
0.73%
0
0
0
0
Total
5 (100)
0.02%
18 (100)
0.04
1 (100)
0.17%
– 58 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
Figure 4: Percentage of male subjects (black columns) and female (gray columns) in accidents with
spiders (Phoneutria = 19 523 cases; Loxosceles = 39,624 cases; Latrodectus = 560 cases) in Brazil during
the years 2009-2013
DISCUSSION
The main animal responsible for poisoning in
Brazil was the scorpion (60,370.8 cases per year).
Snakes were responsible for higher mortality (119
deaths per year) and lethality (0.41%). When the
lethality of snakebite is analysed by country region,
we observed that it is higher in the Northeast =
0.6%, Central-West = 0.47%, and North = 0.46%
and lower in the South = 0.2% and Southeast =
0.27%).4 This shows the need for strategies to
reduce the lethality rates in those regions where
they are higher.
The main factor that may be contributing to
problem of high lethality are the time elapsed
between the accident and the serum therapy.13,14
Improvements in transportation of the victims from
isolated places to the city centres could reduce those
indicators. Many victims also misconduct the
treatment or do not seek hospital care in cases of
poisoning. 3,4 This highlights the importance of
educational campaigns on first aid and the
importance of going to a hospital. Training of health
professionals for the treatment of patients bitten
by poisonous animals, according to the
epidemiological situation and fauna of the region
where it is located, 14,15 is another important
recommendation.
Males aged from 20 to 59 were the main
victims of snakebites, highlighting the importance
of snakebite as an occupational health hazard,
especially in agricultural activities.5 Little difference
in the frequency of accidents with spiders and
scorpions was observed when comparing men and
women. This is probably because most cases of this
type of poisoning occur in urban areas and in houses
where these animals are found. 10,16,17 People
between 20 and 59 years were also the main victims
in cases of poisoning by scorpions and spiders. This
might be associated with activities such as
household chores (cleaning yards and doing
laundry) and handling construction debris and
materials.18,19 A progressive increase in poisonings
was observed from the first year of age until the
age of 20-39 years, and after this, there is a
decrease in all kinds of accidents.
As already reported in other studies on
snakebites,7,20 higher lethality rates were observed
in the elderly and in children. Adults over age 50
are more likely to develop renal failure and adults
over 60 are more likely to present with necrosis in
the bite region.8 Children (under 10 years) have low
immune capacity and less muscle mass than adults
and can have more intense clinical symptoms of
poisoning.21 They are also at increased risk of
reactions to antivenom.22
Pregnant women accounted for 0.5% (about
150 cases per year) of victims of snakebites; this value
is within the observed frequency (0.4% to 1.8%)
found in other studies conducted in South Africa, India
and Sri Lanka.23 Despite this low frequency of cases,
pregnancy had higher mortality (1.33%) compared
to the overall lethality in women (0.39%).
In addition to the increased death rate of
pregnant victims of snakebites, there is also a
possibility of obstetric complications and risk to the
foetus (vaginal bleeding, uterine contraction,
threatened abortion, decrease in foetal movements
and foetal death), 23,24 which requires special
attention for these patients.
Most cases of snakebite corresponded to
bothropic accidents (86.2%) when analysed by
– 59 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
genus of snake followed by crotalic (9%), lachetic
(3.9%) and elapidic (0.9%) accidents, a pattern
that was expected and observed by Bernarde.4 A
higher occurrence of elapid poisonings was observed
in children between 1 and 4 years of age (4.95%)
in relation to accidents by other snakes (1.55% to
1.76%). Because the coral snake (Micrurus spp.)
has a pattern of coloured rings, children who are
unaware of the danger can be compelled to handle
it and then are bitten.21
A higher proportion of males was bitten by
bushmasters (Lachesis muta) (81.76%) and
rattlesnakes (Crotalus durissus) (80.73%),
compared
to
cases
of
poisoning
by
lanceheads (Bothrops) (77.58%) and coral
snakes (Micrurus spp.) (71.06%). This is probably
related to the extra activity of men in forests where
the Lachesis muta is and in areas of crops and
pastures
where Crotalus
durissus is. Bothrops and Micrurus are also present
in urban areas,4 promoting greater contact with
women.
Young people under 14 years old had the
highest mortality as well as lethality in scorpion
accidents, demonstrating that children and
adolescents are a higher risk group, as reported by
Nunes et al.,18 Soares et al.,19 Guerra et al.,25 and
Bucaretchi et al.10 Because elderly persons have
weakened immune systems, they are also a group
at high risk for death and thereby require special
attention.18,19
Accidents with spiders had lower lethality
(0.05%) compared to scorpion and snakes
accidents. Oliveira et al.6 also reported this in Brazil
for the period from 2000 to 2007. The deaths are
more common in adults aged from 20 to 59 years
(50% of cases; average of 6.6 deaths per year),
which are also the majority of victims (63% of
cases). A problem of araneism is the large
proportion of cases in which there is no reference
in the SINAN record to the type of spider that
caused the accident (ignored/White).6 Only 46.3%
of cases recorded the spider’s genus; most of the
cases
were
assigned
to
brown
spider (Loxosceles; 66.3%) followed by Phoneutria
(32.8%) and Latrodectus (0.9%). There was a
higher incidence of loxoscelism in women (56.4%),
probably due to the high number of brown
spiders (Loxosceles) in urban areas and in homes
o f s o u t h e r n B ra z i l , w h e r e m a ny a c c i d e n t s
occur.6,16 Regarding phoneutrism and latrodectism,
most of the accidents occurred to men (59.42%
and 55.35% of cases, respectively), probably due
to the greater male presence in agricultural
activities in rural areas and in others (gardening
and weeding) in the cities.6,12
In conclusion, because of approximately
115,000 cases per year in Brazil, accidents with
snakes, scorpions and spiders have great
importance in public health. There is a progressive
increase of poisoning from the first year of age until
the age of 20-39 years followed by a decrease in
the number of cases.
Children and adolescents (under 14 years old)
and older adults are the most vulnerable groups,
because they have higher lethality rates, especially
with
regards
to
snake
and
scorpion
accidents. Pregnant women have a higher lethality
in cases of snakebites (1.33%) and the possibility
of obstetric complications.
Most cases of snakebites occurred in males,
while there was little difference observed in
frequency of accidents with scorpions and spiders
when comparing men and women. This is probably
related to the increased male activity in the
countryside and forests, where most cases of snake
bite occurs and is also due to the presence of
arachnids in urban areas.
REFERENCES
4.
1.
2.
3.
Chippaux JP, Goyffon M. Epidemiology of
scorpionism: A global appraisal. Acta Trop.
2008; 107(2): 71-9. Doi: http://dx.doi.org/
10.1016/j.actatropica.2008.05.021
WHO - World Health Organization. List of
neglected tropical diseases. 2014. [cited 2014
Nov 12] Available from: http://www.who.int/
neglected_diseases/diseases/en/.
5.
6.
SINAN/SVS/MS. Sistema de Informação de
Agravos de Notificação – Sinan, Ministério da
Saúde, 2014. [cited 2014 Nov 07] Available
from: http://www.saude.gov.br/.
– 60 -
Bernarde PS. Serpentes peçonhentas e acidentes ofídicos no Brasil. São Paulo: Anolis Books;
2014.
Bochner R, Struchner CJ. Epidemiologia dos
acidentes ofídicos nos últimos 100 anos no Brasil: uma revisão. Cad Saúde Pública.
2003;19(1): 7-16. DOI: http://dx.doi.org/
10.1590/S0102-311X2003000100002
Oliveira RC, Wen FH, Sifuentes DN. Epidemiologia dos acidentes por animais peçonhentos.
In: Cardoso JLC, França FOS, Wen FH, Málaque
CMS, Haddad Jr.V. Animais peçonhentos no
Brasil – Biologia, clínica e terapêutica dos acidentes. 2 a ed. São Paulo: Sarvier; 2009;
p. 6-21.
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
7.
8.
9.
10.
11.
12.
13.
14.
15.
Ribeiro LA, Albuquerque MJ, Pires-de-Campos
VAF, Katz G, Takaoka NY, Lebrão ML, et al.
Óbitos por serpentes peçonhentas no estado
de São Paulo: avaliação de 43 casos, 1988/93.
Rev Ass Med Bras. 1998; 44(4):312-318. Doi:
http://dx.doi.org/10.1590/S010442301998000400010.
Ribeiro LA, Gadia R, Jorge MT. Comparação
entre a epidemiologia do acidentes e a clínica
do envenenamento por serpentes do gênero
Bothrops em adultos idosos e não idosos. Rev
Soc Bras Med Trop. 2008; 41(1): 46-49. Doi:
http://dx.doi.org/10.1590/S0037
86822008000100009.
Caiaffa WT, Vlahov D, Antunes CMF, Oliveira
HR, Diniz CR. Snake bite and antivenom
complications in Belo Horizonte, Brazil. Trans
R Soc Trop Med Hyg. 1994; 88(1): 81-85. Doi:
http://dx.doi.org/10.1016/00359203(94)90511-8
Bucaretchi F, Fernandes LCR, Fernandes CB,
Branco MM, Prado CC, Vieira RJ, et al. Clinical
consequences of Tityus bahiensis and Tityus
serrulatus scorpion stings in the region of Campinas, southeastern Brazil. Toxicon. 2014;
89:17-25. Doi: http://dx.doi.org/10.1016/
0035-9203(94)90511-8.
Pardal PPO , Ishikawa EAY, Vieira JLF, Coelho
JS, Dórea RCC, Abati PAM, et al. Clinical
aspects of envenomation caused by Tityus
obscurus (Gervais, 1843) in two distinct regions
of Pará state, Brazilian Amazon basin: a
prospective case series. J Venom Anim Toxins
Incl Trop Dis. 2014; 20(1): 3. Doi: http://
dx.doi.org/10.1186/1678-9199-20-3.
Lira-da-Silva RM, Matos GB, Sampaio RO, Nunes
TB. Estudo retrospectivo de latrodectismo na
Bahia, Brasil. Rev Soc Bras Med Trop. 1995;
28(3):205-210. Doi: http://dx.doi.org/
10.1590/S0037-86821995000300007
Borges CC, Sadahiro M, Santos MC. Aspectos
epidemiológicos e clínicos dos acidentes ofídicos ocorridos nos municípios do Estado do
Amazonas. Rev Soc Bras Med Trop. 1999;
32(6): 637-646. Doi: http://dx.doi.org/
10.1590/S0037- 86821999000600005.
Bernarde PS, Gomes JO. Serpentes
peçonhentas e ofidismo em Cruzeiro do Sul,
Alto Juruá, Estado do Acre, Brasil. Acta Amaz.
2012; 42(1): 65-72. Doi: http://dx.doi.org/
10.1590/S0044-59672012000100008.
Mise YF, Lira-da-Silva RM, Carvalho FM. Envenenamento por serpentes do gênero Bothrops
no estado da Bahia: aspectos epidemiológicos
e clínicos. Rev Soc Bras Med Trop. 2007; 40(5):
569-573. Doi: http://dx.doi.org/10.1590/
S0037-86822007000500015
16. Fisher ML, Vasconcellos-Neto J. Microhabitats
Occupied by Loxosceles intermedia and
Loxosceles laeta (Araneae: Sicariidae) in
Curitiba, Paraná, Brazil. J Med Entomol. 2005;
42(5): 756-765. Doi: http://dx.doi.org/
10.1093/jmedent/42.5.756.
17. Brazil TK, Pinto-Leite CM, Almeida-Silva LM,
Lira-da-Silva RM, Brescovit AD. Aranhas de
importância médica do estado da Bahia, Brasil. Gaz. Méd Bahia. 2009; 79(Supl. 1): 32-37.
18. Nunes CS, Bevilacqua PD, Jardim CCG. Aspectos demográficos e espaciais dos acidentes
escorpiônicos no Distrito Sanitário Noroeste,
município de Belo Horizonte, Minas Gerais, 1993
a 1996. Cad Saúde Pública. 2000; 16( 1): 213223. Doi: http://dx.doi.org/10.1590/S0102311X2000000100022.
19. Soares MRM, Azevedo CS, Maria M. Escorpionismo em Belo Horizonte, MG: um estudo retrospectivo. Rev Soc Bras Med Trop. 2002;
35(4): 359-363. Doi: http://dx.doi.org/
10.1590/S0037-86822002000400013.
20. França FOS, Málaque CMS. Acidente botrópico. Pp. 81-95 In: Cardoso JLC, França FOS, Wen
FH, Málaque CMS, Haddad Jr. V. Animais
peçonhentos no Brasil – Biologia, clínica e terapêutica dos acidentes. 2ª ed. São Paulo:
Sarvier; 2009.
21. Cavazos MEO, Garza CR, Guajardo-Rodríguez
G, Hernández-Montelongo BA Montes-Tapia FD.
Snake bites in pediatric patients, a current view.
Complementary Pediatrics . 2012; p. 123-136.
Doi: http://dx.doi.org/10.5772/34749.
23. Langley RL. Snakebite during pregnancy: a
literature review. Wilderness Environ Med.
2010; 21(1): 54-60. Doi: http://dx.doi.org/
10.1016/j.wem.2009.12.025.
24. Pardal PPO, Mazzeo T, Pinheiro ACL. Snakebite
in pregnancy: a preliminary study. J Venom
Anim Toxins. 1997; 3(2): 280-286. Doi: http:/
/dx.doi.org/10.1590/S0104-7930199
7000200004.
25. Guerra CMN, Carvalho LFA, Colosimo EA, Freire
HBM. Análise de variáveis relacionadas à evolução letal do escorpionismo em crianças e
adolescentes no estado de Minas Gerais no
período de 2001 a 2005. J Pediatr. 2008; 84(6):
509: 515. Doi: http://dx.doi.org/10.1590/
S0021-75572008000700007.
– 61 -
Journal of Human Growth and Development, 2015; 25(1): 54-62
Accidents with poisonous animals in Brazil by age and sex
RESUMO
Introdução: acidentes com animais peçonhentos são uma emergência clínica frequente em vários
países tropicais, principalmente nos campos e áreas rurais, constituindo um problema de Saúde
Pública, inclusive pediátrica. Objetivo: analisar a morbidade, mortalidade e letalidade de acordo
com a faixa etária e sexo nos casos de envenenamentos por serpentes, escorpiões e aranhas no
Brasil. Método: Os dados sobre envenenamentos por serpentes, escorpiões e aranhas ocorridos no
período de 2009 a 2013 foram obtidos na base de dados online do Sistema de Informação de
Agravos de Notificação - SINAN do Ministério da Saúde. Resultados: foi registrada uma média de
28.812 casos por ano de acidentes ofídicos, 60.370,8 com escorpiões e 25.786,4 com aranhas. A
maioria dos óbitos foi causada por serpentes (119 por ano) e também apresentou maior letalidade
(0,41%), seguida por escorpiões (79,6 óbitos) com letalidade de 0,13% e, aranhas (13,2) com
menor letalidade (0,05%). Em indivíduos do sexo masculino ocorreram a maioria dos casos de
acidentes ofídicos, enquanto que nos acidentes com escorpiões e aranhas foi observado pouca
diferença na frequência entre homens e mulheres. A faixa etária com maior número de registros de
envenenamentos foi a de 20 a 39 anos. Conclusões: ocorre um aumento progressivo de casos de
envenenamentos a partir do primeiro ano de idade até a faixa etária compreendida entre 20 a 39
anos e após esta, começa uma diminuição. Crianças, adolescentes e adultos idosos, constituem
grupos mais vulneráveis por apresentarem maiores índices de letalidade, especialmente nos acidentes
ofídicos e escorpiônicos.
Palavras-chaves: acidentes ofídicos, ofidismo, escorpionismo, araneísmo.
– 62 -